Job description

Pay: $30

Hours: 8-5 PST

Location: Remote. Must live in Rancho Cucamonga. Will be onsite for first 30 days of training after that fully remote.

Position Details:

• Responsible for gathering of clinical documentation to assist the R.N. Letter Review Nurse and Medical Director with decision of prospective/pre-service, concurrent, or retrospective reviews based on clinical criteria for appropriateness of outpatient services and care.
• Works collaboratively with the UM clinical team to ensure regulatory timeframes are upheld for authorization of concurrent, outpatient or ancillary services as per approved clinical criteria, including but not limited to, outpatient surgery, durable medical equipment, home health, etc.
• Serves as a resource for Member and Provider Service departments for outpatient utilization management, referral, and continuity of care issues.
• Works with Contracts Department to identify gaps in provider network.

Position Requirements:

• High School diploma or GED required
• 2+ years of experience in Utilization Management in a healthcare delivery setting
• 1+ years of experience in a HMO or Managed care setting
• Must have a valid CA Drivers License
• LVN License

#INDAS

Job Type: Full-time

Pay: $30.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Utilization Management in Healthcare Delivery Setting: 2 years (Required)
• HMO or Managed Care: 1 year (Required)

License/Certification:

• LVN (Required)

Work Location: Remote

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